微型钛板法与锚定法颈后路单开门椎管扩大成形术的临床疗效和颈椎矢状面平衡的变化

doi:10.3969/j.issn.1006-7795.2019.04.003

摘要/Abstract

摘要： 目的探讨微型钛板法与锚定法颈后路单开门椎管扩大椎板成形术的临床疗效和颈椎矢状面参数及平衡的变化。方法选择2016年1月至2017年12月首都医科大学附属北京朝阳医院收治的61例多节段脊髓型颈椎病患者，根据手术方式分为微型钛板法后路单开门组（A组），共29例；锚定法后路单开门组（B组），共32例。记录手术时间、术中出血量，术前及术后12个月的颈痛视觉模拟评分（Visual Analogue Score，VAS）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及脊髓神经功能改善率、颈椎功能障碍指数（Neck Disability Index，NDI）。比较术前、术后3 d及术后12个月时，颈椎X线侧位片上C2椎体矢状面垂直轴线至C7椎体后上缘的距离（C2-7 SVA）、C2与C7椎体后缘切线夹角（C2-7 Cobb角）、T1椎体上缘连线与水平线的交角（T1 Slope）。结果两组患者术前年龄、病程、颈痛VAS、JOA评分、NDI评分及手术时间、术中出血量均差异无统计学意义（P>0.05）。术后两组患者颈痛VAS、NDI评分明显降低，JOA评分明显增加。术后12个月时，颈椎NDI评分A组优于B组（P<0.05），其他指标均相似（P>0.05）。在影像学参数上，术后两组C2-7 SVA和T1 Slope均增加，C2-7 Cobb角均减小（P<0.05）。术后12个月时，两组的C2-7 SVA比较差异有统计学意义（P<0.05），其他参数比较差异无统计学意义（P>0.05）。术前与术后12个月时，影像学参数C2-7 SVA差值与临床指标NDI评分差值之间存在负相关（P<0.05）。结论两种术式术后颈椎都有前倾，但微型钛板法术后患者的颈椎矢状面平衡优于锚定法，其颈椎功能状态亦优于锚定法。

关键词: 颈椎单开门椎管扩大成形术, 微型钛板法, 锚定法, 颈椎, 矢状面平衡

Abstract: Objective To investigate clinical efficacy and cervical sagittal balance after posterior open-door laminoplasty with mini-plate and anchor.Methods From January 2016 to December 2017, 61 patients with multilevel cervical spondylotic myelopathy were retrospectively studied in our department. According to the different fixation methods, all patients were divided into cervical posterior open-door Centerpiece fixation group(group A, 29 cases)and cervical posterior open-door anchor fixation group(group B, 32 cases).The important clinical data were recorded, including operation time, intraoperative bleeding volume, Visual Analogue Score (VAS) of cervical pain, Japanese Orthopaedic Association (JOA) score, improvement rate of spinal nerve function and Neck Disability Index (NDI) of cervical spine at pre- and post-operation of 12 months. This parameters were compared at pre-operation, 3 days and 12 months after surgery, which were the distance between the vertical axis of C2 sagittal plane and the posterior superior edge of C7 (C2-7 SVA), the inclusion angle of tangent between C2 and C7 trailing edge (C2-7 Cobb angle), and the intersection angle between the upper edge of T1 and the horizontal line (T1 Slope).Results The age, disease duration, VAS, JOA score and NDI score were no statistical difference between the two groups before operation(P>0.05). There were no significant difference in operation time and bleeding volume between the two groups(P>0.05). After surgery, the VAS and NDI score in the two groups were significantly lower than those before operation, but the JOA score was higher. At 12 months after surgery,the NDI score in group A was better than that in group B(P<0.05), while there was no statistical difference in the others between the two groups (P>0.05).In radiological parameters, compared with pre- and post-operation, C2-7 SVA and T1 Slope in both groups increased, while the C2-7 Cobb angle decreased(P<0.05). But there were statistical differences in C2-7 SVA at 12 months after operation(P<0.05), while other parameters were no differences (P>0.05). Before and 12 months after operation, C2-7 SVA difference was negatively correlated with NDI score difference (P<0.05). Conclusion Both surgical methods caused anteversion of cervical spine, but cervical sagittal balance and function after mini-plate is better than that of anchor.

Key words: posterior open-door laminoplasty, mini-plate, anchor, cervical spine, sagittal balance

中图分类号:

R681.5⁺5

李冬月, 海涌, 刘玉增, 关立, 孟祥龙. 微型钛板法与锚定法颈后路单开门椎管扩大成形术的临床疗效和颈椎矢状面平衡的变化[J]. 首都医科大学学报, 2019, 40(4): 503-509.

Li Dongyue, Hai Yong, Liu Yuzeng, Guan Li, Meng Xianglong. Clinical efficacy and cervical sagittal balance after posterior open-door laminoplasty with mini-plate and anchor[J]. Journal of Capital Medical University, 2019, 40(4): 503-509.

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